Provider Demographics
NPI:1063046019
Name:NGR LLC
Entity type:Organization
Organization Name:NGR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-791-1048
Mailing Address - Street 1:1111 SUPERIOR ST STE 304
Mailing Address - Street 2:
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-4156
Mailing Address - Country:US
Mailing Address - Phone:708-786-7100
Mailing Address - Fax:708-786-7101
Practice Address - Street 1:1111 SUPERIOR ST
Practice Address - Street 2:SUITE 304
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-4156
Practice Address - Country:US
Practice Address - Phone:708-786-7100
Practice Address - Fax:708-786-7101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-28
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036078622OtherSTATE LICENCE